Provider Demographics
NPI:1366030843
Name:CLARK, MATTHEW SCOTT (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:CLARK
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 P ST NW APT 708
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3382
Mailing Address - Country:US
Mailing Address - Phone:717-379-2790
Mailing Address - Fax:
Practice Address - Street 1:3029 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2506
Practice Address - Country:US
Practice Address - Phone:202-948-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011603101YP2500X
DCPRC15451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional